| NPI | 1609843796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00341200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC003513L) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-09-25 |