| NPI | 1568947760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011409) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000979) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2022-06-22 |