| NPI | 1740662733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: VA 0104-557265) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557265) |
| 111N00000X Chiropractor (Licence: CA 33243) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-06-25 |