| NPI | 1750322681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-006504-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00636900) |
| 111N00000X Chiropractor (Licence: NY X008083) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-07-08 |