| NPI | 1851659890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010591) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4270) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2016-12-30 |