| NPI | 1962446922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC006801L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000417) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-08 |