| NPI | 1710063748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009704) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03397) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2008-10-15 |