| NPI | 1366698672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008383) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2013-01-31 |