| NPI | 1760791214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4260) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010316) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2020-01-20 |