| NPI | 1215951918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-006195-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ-006195-L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2015-05-11 |