| NPI | 1164537130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 44421) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104000271) |
| 111N00000X Chiropractor (Licence: DC CH30035) | |
| 171100000X Acupuncturist | |
| 171100000X Acupuncturist | |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC 17362) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-05-16 |