| NPI | 1053529347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 3001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B00424) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-09-28 |