| NPI | 1588785224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555948) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2017-03-02 |