| NPI | 1326100280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1894) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH3099) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2018-06-16 |