| NPI | 1376729376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556839) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2008001511) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2019-06-11 |