| NPI | 1043455736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC005968L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 007704) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2008-12-09 |