| NPI | 1467679696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-004820-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001588) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |