| NPI | 1891788352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003170L) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: PA DC003170) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-08-07 |