| NPI | 1356490999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC004576L) |
| Additional Taxonomies | 111NR0400X (Licence: PA dc004576L) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-11-06 |