| NPI | 1568915668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011165) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000989) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2019-05-22 |