| NPI | 1194917732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2009-01103) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NC 3777) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2020-10-25 |