| NPI | 1861905309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557617) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012965) |
| 111N00000X Chiropractor (Licence: NY 012965) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2020-01-02 |