| NPI | 1912019340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC8637) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: PA DN003994) |
| 133V00000X Dietitian, Registered (Licence: PA DN003994) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-06-10 |