| NPI | 1548368913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA AJ0008536) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC - 008003-L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-11-07 |