| NPI | 1427299783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10133) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009623) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2012-04-03 |