| NPI | 1083652804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA dc009078) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ008904) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-07-17 |