| NPI | 1841251931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC008875) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit (Licence: PA DC008875) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2010-07-22 |