| NPI | 1457647455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000336) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000002401) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |