| NPI | 1346438355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00727200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009820) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2018-08-23 |