| NPI | 1386298917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557595) |
| Additional Taxonomies | 111NR0200X Chiropractor Radiology (Licence: VA 0104-557595) |
| 111NR0400X Chiropractor Rehabilitation (Licence: VA 0104-557595) | |
| 111NS0005X Chiropractor Sports Physician (Licence: VA 0104-557595) | |
| 111NX0800X Chiropractor Orthopedic (Licence: VA 0104-557595) | |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |