| NPI | 1801947130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2113) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC001553L) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2009-08-06 |