| NPI | 1417143744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009842) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ009655) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2009-07-27 |