| NPI | 1982756722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD SO1389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD SO1389) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |