| NPI | 1174590525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556436) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009590) |
| 111N00000X Chiropractor (Licence: MO 2006005941) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2007-07-08 |