| NPI | 1699897991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03435MD) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 01045596328) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2012-03-14 |