| NPI | 1700886843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556477) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x009806) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2023-07-06 |