| NPI | 1790795771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC001284-L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 001284-L) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2008-08-23 |