| NPI | 1851401087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03677) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3455) |
| 111N00000X Chiropractor (Licence: VA 0104556916) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-07-03 |