| NPI | 1366550071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3071) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-07-10 |