| NPI | 1992140180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A6217) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4986) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2019-01-08 |