| NPI | 1881259232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011573) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003081A) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-01-04 |