| NPI | 1407827009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01984) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 010455583) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2015-12-02 |