| NPI | 1073586616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC004154L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 6129) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-08-04 |