| NPI | 1770789950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 47882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007010882) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2024-07-02 |