| NPI | 1538136726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC1689L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV DC242) |
| 111N00000X Chiropractor (Licence: TN DC181) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2018-05-07 |