| NPI | 1528216504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011470) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2008026720) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2022-11-23 |