| NPI | 1871206912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011785) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ011370) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |