| NPI | 1407827082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555984) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S02175) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MD S02175) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2014-10-09 |