| NPI | 1851540769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009843) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO 4836) |
| 171100000X Acupuncturist (Licence: CO 4836) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-03-09 |