| NPI | 1598760696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC01755) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F10000166) |
| 111N00000X Chiropractor (Licence: PA DC006478R) | |
| 111N00000X Chiropractor (Licence: SC 2759) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2008-08-21 |