| NPI | 1518696665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011763) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00790800) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-06-24 |