| NPI | 1124053905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC006207L) |
| Additional Taxonomies | 111NR0400X (Licence: PA dc-006207-l) |
| 111NR0400X (Licence: CO 0008197) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: PA DC-OO6207-L) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-05-13 |