| NPI | 1285709204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00484700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC006602L) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2014-10-28 |