| NPI | 1972552743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00334) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2014-05-01 |