| NPI | 1710257506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010602) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2015-03-04 |