| NPI | 1639473812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0073741) |
| 111N00000X Chiropractor (Licence: NJ 38MC00445500) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2021-01-09 |