| NPI | 1699840603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009889) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 9214) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2019-03-21 |