| NPI | 1568635050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ009755) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2008-04-07 |