| NPI | 1770615403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: MD S01328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD S01328) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2024-12-10 |