| NPI | 1962485565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 952826501202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC-002455-L) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2015-09-09 |