| NPI | 1124145180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: VA 0104556819) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23418) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2012-06-05 |