| NPI | 1558765123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557794) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4501) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2022-03-02 |