| NPI | 1508879198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010098) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011077-1) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-06-11 |