| NPI | 1720606213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557687) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5131) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2023-04-18 |