| NPI | 1003879263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003583L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH5649) |
| 111N00000X Chiropractor (Licence: GA CHIR002674) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2008-03-14 |