| NPI | 1558703447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007677) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2014-03-24 |