| NPI | 1235498452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD SO3689) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557432) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2019-01-02 |