| NPI | 1124397260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: NV B-609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B00609) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2013-02-15 |