| NPI | 1497700249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-004333-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC00396400) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2013-01-16 |