| NPI | 1386858074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556499) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008117) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2010-04-14 |