| NPI | 1588600910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008147) |
| 111N00000X Chiropractor (Licence: VA 1528) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2007-07-08 |