| NPI | 1538268925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-000368) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007753-1) |
| 111N00000X Chiropractor (Licence: PA DC005512L) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-10-06 |