| NPI | 1891742219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC005646L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00498300) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2012-10-10 |