| NPI | 1396927901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009879) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ009695) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |