| NPI | 1073819678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010343) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0102119) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2015-11-24 |