| NPI | 1326344839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: PA DC010528) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: PA Student) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2023-03-08 |