| NPI | 1851550206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556734) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3866) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2020-10-22 |