| NPI | 1144315284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC005039L) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 247200000X Technician, Other | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-08-10 |