| NPI | 1033214572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007715) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009107) |
| 111N00000X Chiropractor (Licence: NC 3112) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |