| NPI | 1801644620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011913) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC011913) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-09-20 |