| NPI | 1790025849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011023) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-04735) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2018-08-10 |