| NPI | 1083045835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010814) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012496) |
| 111N00000X Chiropractor (Licence: PA AJ010598) | |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2015-09-22 |