| NPI | 1912047838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556551) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3229) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |