| NPI | 1063528958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101012371) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301003007) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 2238841) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2013-12-10 |