| NPI | 1124003868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556410) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X09345) |
| 111N00000X Chiropractor (Licence: WV 892) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-11-12 |