| NPI | 1346282878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000854) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1772) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2017-01-14 |