| NPI | 1265487441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00542500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007342L) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-07-20 |