| NPI | 1225268147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11961) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010072) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2013-05-06 |