| NPI | 1669721692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4296) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ010434) |
| 111N00000X Chiropractor (Licence: PA DC010641) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2023-09-07 |