| NPI | 1891845764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2184) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC-007408-L) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-03-27 |