| NPI | 1932206646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00607500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009785) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2010-10-27 |