| NPI | 1902981236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104001086) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: VA 0104001086) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-07-08 |