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