| NPI | 1609071281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: VA 0104557816) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: IL 038-007498) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2023-02-21 |