| NPI | 1205996782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: VA 0101049169) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MD D34024) |
| 111NN0400X Chiropractor, Neurology (Licence: DC MD22073) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |