| NPI | 1366424178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2157) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009204) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2013-08-05 |