| NPI | 1174752844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03719) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556707) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2019-01-25 |