| NPI | 1154637783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03638) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010300) |
| 111N00000X Chiropractor (Licence: PA AJ010099) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2014-09-12 |