| NPI | 1801216304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557380) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11140) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2016-12-27 |