| NPI | 1700106499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00693400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010433) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2011-10-11 |