| NPI | 1235229097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104001121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY XOO9292) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-06-19 |