| NPI | 1992854467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC 009739) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ 009545) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-06-24 |