| NPI | 1578538898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8057) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008961) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 4715) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2012-08-06 |