| NPI | 1871750430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009893) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2019-10-25 |