| NPI | 1467051094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: PA DC011579) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011579) |
| 111NS0005X Chiropractor Sports Physician (Licence: PA DC011579) | |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2020-10-28 |