| NPI | 1114087137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000759) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S01413) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-09-23 |