| NPI | 1407030653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556637) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011498) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2014-07-08 |