| NPI | 1215984463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 834) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00519900) |
| 111N00000X Chiropractor (Licence: PA DC007362L) | |
| 111N00000X Chiropractor (Licence: DE F1-0000469) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2013-07-03 |