| NPI | 1831314897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01385) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MD S01385) |
| 111NR0200X Chiropractor, Radiology (Licence: MD S01385) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MD S01385) | |
| 225100000X Physical Therapist (Licence: MD S01385) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-10-15 |