| NPI | 1689071482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010911) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5986) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2017-08-03 |