| NPI | 1750398103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556713) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3698) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-06-19 |