| NPI | 1154329118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA dc8636) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA dc8636) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2013-10-11 |