| NPI | 1225699234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557606) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 04009) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-09-24 |