| NPI | 1528015898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009125) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AS008951) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-12-16 |