| NPI | 1801286091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010991) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00724600) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2024-04-30 |