| NPI | 1720405533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557181) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03777) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2015-09-01 |