| NPI | 1851468995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 01688) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2018-06-14 |