| NPI | 1750697413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010535) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4997) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2012-02-03 |