| NPI | 1386806701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00671100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010042) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2024-01-30 |