| NPI | 1780871731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000002195) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2016-08-02 |