| NPI | 1649207317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003545L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC003446900) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2018-11-30 |