| NPI | 1902310600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557553) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011314) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2019-04-03 |