| NPI | 1699709055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 003388) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001332) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-07-22 |