| NPI | 1235431701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 008745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA 010359) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: PA 010359) | |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: GA CHIR008745) | |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2010-12-03 |