| NPI | 1518938364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC008861) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00670700) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-11-01 |