| NPI | 1063475457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA 2203) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA L2203) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2020-05-15 |