| NPI | 1548860778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557696) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 123456) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-28 |