| NPI | 1952343972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009627) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010509-1) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-02-12 |