| NPI | 1164464061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2185) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009190) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-12-26 |