| NPI | 1083897110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: VA 0104556329) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: VA 0104556329) |
| 111NS0005X Chiropractor Sports Physician (Licence: VA 0104556329) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |