| NPI | 1508887654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00469100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC006211L) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2010-03-03 |