| NPI | 1801301585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03957) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2022-08-08 |