| NPI | 1972714079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-555801) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104-555801) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-01-27 |