| NPI | 1013334994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: VA 0102202034) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: CA 20A12674) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-07-09 |