| NPI | 1962279919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557862) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: VA 0104557862) |
| 111NN1001X Chiropractor, Nutrition (Licence: VA 0104557862) | |
| 111NR0400X (Licence: VA 01045578862) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: VA 01045578862) | |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |