| NPI | 1770695553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8136) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC 005311) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-07-06 |