| 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 |