| NPI | 1982898037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010255) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008264) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2010-11-02 |