| NPI | 1861480352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC001560L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 203) |
| 111N00000X Chiropractor (Licence: GA CHIR001148) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2014-12-17 |