NPI | 1902123375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT216324) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4070) |
Enumeration Date | 2010-04-26 |
Last Update Date | 2024-03-27 |