| NPI | 1316010028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01729) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 1315) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2022-08-23 |