| NPI | 1669717161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010673) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR0008173) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-09-20 |