| NPI | 1194839654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC4909C) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC004909L) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-02-04 |