| NPI | 1750652210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010542) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ010334) |
| Enumeration Date | 2012-01-14 |
| Last Update Date | 2012-01-14 |