| NPI | 1013123264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 7229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 4078) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2008-03-18 |