| NPI | 1346332871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC001664L) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC001664L) |
| 111NX0100X Chiropractor, Occupational Health (Licence: PA DC001664L) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2022-07-21 |