| NPI | 1760407811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556095) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009529) |
| 111N00000X Chiropractor (Licence: SC 3138) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |