| NPI | 1588743579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 0922) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 271-0687A) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2012-11-13 |