| NPI | 1093254369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03914) |
| Enumeration Date | 2017-02-19 |
| Last Update Date | 2017-02-22 |