| NPI | 1609859081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC3963) |
| 111N00000X Chiropractor (Licence: GA 8793) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2013-07-01 |