| NPI | 1386791820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: VA 0104556439) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC009617) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |