| NPI | 1568429413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 449) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4198) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-12-15 |