| NPI | 1295722940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000644) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104000644) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2011-12-01 |