| NPI | 1679672588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA AJ003821L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC003821L) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2025-09-11 |