| NPI | 1053747543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557093) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03678) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2013-09-17 |