| NPI | 1801286273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ010758) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2015-01-23 |