| NPI | 1518338953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: VA 0104557945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03875) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2024-11-12 |