NPI | 1861491003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-007201-L) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00616800) |
Enumeration Date | 2005-07-19 |
Last Update Date | 2016-03-23 |