| NPI | 1114487386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104-557583) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 002137) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MD S04021) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: DC CH030207) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2021-12-09 |