| NPI | 1457341091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC003642L) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: RI DCP00571) |
| 111NR0400X Chiropractor Rehabilitation (Licence: CT 001713) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2015-11-02 |