| NPI | 1114096211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: PA DC009554) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: PA DC009554) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-11-09 |