| NPI | 1861751646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010601) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-10-16 |