| NPI | 1124030911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC005467R) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-10-07 |