| NPI | 1376693465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 282) |
| 111N00000X Chiropractor (Licence: PA DC001905L) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MD S01129) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: WV 282) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC001905L) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2025-09-11 |