| NPI | 1316093545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000941) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC4755L) |
| 111N00000X Chiropractor (Licence: NJ 38MC00413500) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2019-07-25 |