| NPI | 1871557231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA NA) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC004943L) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2020-11-04 |