| NPI | 1952426751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC-004209-L) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: PA DC-004209-L) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2024-05-20 |