| NPI | 1861059859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011379) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: PA AJ011111) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |