| NPI | 1407002066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000919) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005728) |
| 171100000X Acupuncturist (Licence: VA 0104000919) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2009-02-13 |