| NPI | 1144345760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009599) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: PA AJ009567) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-06-06 |