| 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 (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 |