| NPI | 1275545410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010174) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 28834) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2011-04-22 |