| NPI | 1710056114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC008802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034241) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-09-19 |