| NPI | 1598770208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: VA 0104001977) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: MD 02006) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2019-12-17 |