| NPI | 1932793833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-05043) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2022-05-20 |