| NPI | 1083056683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010739) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012362) |
| 111N00000X Chiropractor (Licence: DE F1-0000872) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2023-02-28 |