| NPI | 1033219407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 501306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 501306) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-07-10 |