| NPI | 1174020119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104557601) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR010044) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2021-07-15 |