| NPI | 1902963366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556493) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: DC CH030069) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-10-05 |