| NPI | 1528257953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01397) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD S01397) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2015-09-22 |