| NPI | 1881664761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-005304-L) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: PA AJ--005304) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2011-01-07 |