| NPI | 1114955192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01387) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 3485) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2012-03-14 |