| NPI | 1245691435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: MD S03869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03869) |
| 225100000X Physical Therapist (Licence: MD S03869) | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2016-03-15 |