| NPI | 1144295189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD433329) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC001626L) |
| 207Q00000X Family Medicine (Licence: OH 89802) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2008-01-25 |