| NPI | 1770761652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009904) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2025-03-27 |