| NPI | 1982995080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010347) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000815) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2021-04-12 |