| NPI | 1275512014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIROO8283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009338) |
| 174400000X Specialist (Licence: PA AJ009151) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2017-05-24 |