| NPI | 1821374356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010499) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10460) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2015-08-20 |