| NPI | 1013288315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010545) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ010337) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2017-10-30 |