| NPI | 1265701536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: PA 010504) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: PA 010504) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2011-12-15 |