| NPI | 1659306553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-004802-Y) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F10000334) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |