| NPI | 1609077411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00689500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009062) |
| 111N00000X Chiropractor (Licence: NY x006311) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2016-10-11 |