| NPI | 1225182694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC004959L) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: PA DC004959L) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2011-10-20 |