| NPI | 1376690750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00606300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009084) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-09-08 |