| NPI | 1801914809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556577) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10496) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2009-03-04 |