| NPI | 1063738995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000790) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010264) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ010063) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2012-06-27 |