| NPI | 1861539967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00476700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA dc005557l) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2015-05-07 |