| NPI | 1235207465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: MD 03838) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03838) |
| 111NR0400X (Licence: VA 0104002090) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-08-30 |