| NPI | 1093759953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009846) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011073) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2026-02-25 |