| NPI | 1053681528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556932) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2012-06-13 |