| NPI | 1427020817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00636400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009386) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2007-07-08 |