| NPI | 1164796207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01456) |
| 111NN1001X Chiropractor, Nutrition (Licence: NV B01456) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV B01456) | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2022-08-10 |