| NPI | 1649239799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-4357 L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY NY--X6167) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2007-07-08 |