| NPI | 1134774177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5262) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011496) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-01-12 |