| NPI | 1518065499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00317400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC002708L) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-05-31 |