| NPI | 1205946373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000212) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 01116) |
| 111N00000X Chiropractor (Licence: AL 0901I) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-08-15 |