| NPI | 1932178142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9612) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2018-10-31 |