| NPI | 1124273982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC-003905R) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 4084) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2010-03-26 |