| NPI | 1548861198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011673) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13274) |
| 111N00000X Chiropractor (Licence: PA AJ011303) | |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2021-09-21 |