| NPI | 1851390652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 730) |
| 111N00000X Chiropractor (Licence: WI 4280) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2008-08-25 |