| NPI | 1770674939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC002956L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00319200) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-05-11 |