| NPI | 1679723720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556491) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30297) |
| 171100000X Acupuncturist (Licence: VA 0121000759) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2015-05-27 |