| NPI | 1841297579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009380) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x009993-1) |
| 111NN1001X Chiropractor, Nutrition (Licence: PA DC009380) | |
| 111NN1001X Chiropractor, Nutrition (Licence: NY x009993-1) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-05-17 |