| NPI | 1003010075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556609) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2012-07-03 |