| NPI | 1982039723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010918) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2694) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2016-11-30 |