| NPI | 1679637623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557201) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4710) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2022-09-29 |