| NPI | 1235461062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556840) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03639) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2022-07-21 |