| NPI | 1639109606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556352) |
| Additional Taxonomies | 225700000X Massage Therapist |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2026-03-19 |