| NPI | 1902810849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003615L) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC 003615 L) |
| 111NR0200X Chiropractor, Radiology (Licence: PA DC 003615 L) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-07-08 |