| NPI | 1790024537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010700) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2013-08-19 |