| NPI | 1538112693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009020) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: WV 1038) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-09-16 |