| NPI | 1508050667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556899) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3739) |
| 111N00000X Chiropractor (Licence: IN 08002439A) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2024-11-14 |