| NPI | 1578960563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011022) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3487) |
| 171100000X Acupuncturist (Licence: PA AK001148) | |
| 111N00000X Chiropractor (Licence: NY X012596) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2015-07-12 |