| NPI | 1396805081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MA002389L) |
| Additional Taxonomies | 111NX0100X Chiropractor Occupational Health (Licence: MD C0000472) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-08-06 |