| NPI | 1215960158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 1088) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 112-0546-0183A) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2012-10-29 |