| NPI | 1295754976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC007387L) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00589200) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-10-06 |