| NPI | 1588725634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC001938L) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-11-13 |