| NPI | 1952474694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556908) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011166-1) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2016-08-31 |