| NPI | 1447587456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010167) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ009974) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2012-09-10 |