| NPI | 1750486098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC3797L) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: PA AJ-3797-L) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2014-02-21 |