| NPI | 1902031644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009614) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31271) |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2021-05-26 |