| NPI | 1841400280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557360) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009775) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-10-12 |