| NPI | 1518603422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC012044) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013604) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2025-07-08 |