| NPI | 1518455484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: VA 1518455484) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557452) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2022-05-02 |