| NPI | 1942897467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-011722) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-05038) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2022-02-04 |