| NPI | 1720204597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009770) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ009576) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-06-15 |