| NPI | 1891768305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC007995L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ007995L) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-11-30 |