| NPI | 1275509812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011299) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7543) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2018-04-16 |