| NPI | 1477829497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: VA 0104001097) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001097) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |