| NPI | 1568678183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC007094-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ007094-L) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-03-22 |