| NPI | 1558422758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD SO1445PT) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC003877L) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2015-10-27 |