| NPI | 1710199898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC-008001-L) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA ADJ-008001-L) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |