| NPI | 1649475872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: PA DC2794) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: PA DC2794) |
| 111NS0005X Chiropractor, Sports Physician (Licence: PA DC2794) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-07-08 |