| NPI | 1407817000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00624400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009027) |
| 111N00000X Chiropractor (Licence: NY X010691-1) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-04-29 |