| NPI | 1508989336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009783) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK000923) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2009-11-05 |