| NPI | 1588876270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556372) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 7.002086) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-24 |