| NPI | 1891836292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556527) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7447) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2008-12-16 |