| NPI | 1649286717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC006598-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008443) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-04-04 |