| NPI | 1063556595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3526) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 571-0999) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2010-05-17 |