| NPI | 1659496834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00198700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC002056L) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-09-06 |