| NPI | 1699892992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: PA DC001427L) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC001427L) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-09-11 |