| NPI | 1578955035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4550) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2023-12-21 |