| NPI | 1801889464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3050) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555998) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2007-07-08 |