| NPI | 1619932431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: AZ 4276) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: AZ 7589) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2022-07-21 |