| NPI | 1679612956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA dc007284l) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC007284L) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-12-08 |