| NPI | 1336290261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1130) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC-002887-L) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-11-21 |