| NPI | 1871201608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011436) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ011365) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2026-06-04 |