| NPI | 1760479232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC007899L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00579500) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2014-03-18 |