| NPI | 1245230929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC002723L) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: PA DC002723L) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-06-11 |