| NPI | 1730181041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11641) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00626100) |
| 111N00000X Chiropractor (Licence: PA DC-007938-L) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-04-11 |