| NPI | 1346323771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00598900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008757) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2012-04-09 |