| NPI | 1245298439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556394) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 787) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2008-06-17 |