| NPI | 1295709707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC0075967) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE FI0000586) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2007-07-08 |