| NPI | 1528164712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA aj008674) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008729) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2025-09-11 |