| NPI | 1376322677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557937) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: VA 0104557937) |
| 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104557937) | |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2024-06-06 |