| NPI | 1801443791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00764300) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA OM000304) |
| 111N00000X Chiropractor (Licence: PA DC011656) | |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2022-09-16 |