| NPI | 1194272450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: VA 0104557883) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557883) |
| 111N00000X Chiropractor (Licence: MD 04183) | |
| Enumeration Date | 2016-09-04 |
| Last Update Date | 2023-08-21 |