| NPI | 1336701036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011890) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000992) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2026-05-14 |