| NPI | 1508289869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009503) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010650) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2018-01-31 |