| NPI | 1508084179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009631) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: PA AJ009433) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: PA AJ009433) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: PA DC009631) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-02-24 |