| NPI | 1225025463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC001742L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1406) |
| 111N00000X Chiropractor (Licence: AZ 4829) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2011-12-28 |