| NPI | 1497088140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010160) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00684000) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2025-01-16 |