| NPI | 1538120423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003737L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ003737L) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2008-02-14 |