| NPI | 1508873662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003400L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 564) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2008-04-08 |