| NPI | 1386610574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003246L) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK000902) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2009-01-13 |