| NPI | 1871685677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S02141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD SO2141) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-09-09 |