| NPI | 1740220912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003773L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 450526577) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-06-29 |