| NPI | 1346536760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00175200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC001696L) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |