| NPI | 1598855959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556763) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 656) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-09-26 |