| NPI | 1831571793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557570) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MD A0000719) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2019-05-01 |