| NPI | 1023161106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104000956) |
| 111N00000X Chiropractor (Licence: DC CH20038) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2014-08-25 |