| NPI | 1164790499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC011192) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10492) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2019-06-12 |