| NPI | 1841560489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: VA 0104556946) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556946) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2024-04-08 |