| NPI | 1912079146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 333) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007158R) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2012-03-23 |