| NPI | 1760475743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1125) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 515) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2016-02-04 |