| NPI | 1720486699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16266) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010974) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2024-10-23 |