| NPI | 1598996977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC010651) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007226) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2014-03-18 |