| NPI | 1891804498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: PA DC010306) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1772) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-08-05 |