| NPI | 1972502250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: VA 0104000707) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104000707) |
| 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104000707) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2020-04-27 |