| NPI | 1932159365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03454) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC005010L) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-04-18 |