| NPI | 1780623231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00610700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007539L) |
| 111N00000X Chiropractor (Licence: PA AJ007539L) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2016-05-11 |