| NPI | 1063652501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 1046) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 1614) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2012-05-07 |