| NPI | 1023115110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555910) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: VA 0104555910) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-11-08 |