| NPI | 1205128295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3632) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010425) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2012-03-08 |