| NPI | 1235354077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001654) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009773) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-04-16 |