| NPI | 1952371726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK AK507) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009231) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2010-06-30 |