| NPI | 1477972164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-04826) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010881) |
| 111NR0400X (Licence: PA AJ010659) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2019-01-24 |