| NPI | 1033462361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557024) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03697) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2016-10-26 |