| NPI | 1487856662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC008706) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555980) |
| 111N00000X Chiropractor (Licence: NY X010410) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2009-06-25 |