| NPI | 1710045695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 1616) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 903) |
| 111N00000X Chiropractor (Licence: TX 5547) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |