| NPI | 1790257368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011441) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ011152) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |