| NPI | 1629409081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010797) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012396) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2024-04-30 |