| NPI | 1194701896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7227) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008785) |
| 111N00000X Chiropractor (Licence: AZ 3913) | |
| 111N00000X Chiropractor (Licence: MA 2688) | |
| 111N00000X Chiropractor (Licence: PA AI008658) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2018-02-23 |