| NPI | 1003055989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010069) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5196) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2010-12-01 |