| NPI | 1467985952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00744500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA Dc011241) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |