| NPI | 1780048082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557343) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011147) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-05-20 |