| NPI | 1093013724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556939) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11668) |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2012-04-27 |