| NPI | 1346510906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010540) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2013-05-14 |