| NPI | 1861491003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-007201-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00616800) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2016-03-23 |