| NPI | 1861432734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: VA 1199) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 007252) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-11-10 |