| NPI | 1932413861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556789) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03630) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2012-10-05 |