| NPI | 1679211254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104-557828) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104557828) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2025-07-08 |