| NPI | 1053418715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03493) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2173) |
| 111N00000X Chiropractor (Licence: VA 0104556486) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |