| NPI | 1932199825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003026L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA dc-003026-l) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2015-11-04 |