| NPI | 1366427676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 2639) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 857) |
| 225100000X Physical Therapist (Licence: NM 1694) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2013-08-14 |