| NPI | 1346554847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03547) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556592) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2013-08-22 |