| NPI | 1063623957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 858) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007543-L) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2009-01-27 |