| NPI | 1285787150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104001895) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104002895) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-03-26 |