| NPI | 1215350624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011090) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MSG008660) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2024-03-04 |