| NPI | 1932200375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009968) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH OH3663) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-03-07 |