| NPI | 1194255414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011569) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013115) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-12-13 |