| NPI | 1891049771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03836) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557030) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MD S03836) | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2020-12-17 |