| NPI | 1013250075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010706) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000857) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2015-03-26 |