| NPI | 1285624965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 104001575) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 008156) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2019-03-12 |