| NPI | 1245278076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC004889L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 767) |
| 111N00000X Chiropractor (Licence: CO 5082) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-06-08 |