| NPI | 1225081631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC005947L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004477) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-09 |