| NPI | 1679699631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555818) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 02041) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2014-03-21 |