| NPI | 1053717751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4452) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557145) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |