| NPI | 1962462697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC00416L) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: PA dc-oo4164-l) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2008-02-19 |