| NPI | 1295067197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557288) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011950-1) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2018-11-27 |