| NPI | 1851510333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.010926) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2016-06-18 |