| NPI | 1346861036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC012006) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA TSMG000956) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2024-12-27 |