| NPI | 1770949943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011103) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC011103) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2020-02-06 |