| NPI | 1598811531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC005583L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F10000646) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |