| NPI | 1962559534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006030) |
| 111N00000X Chiropractor (Licence: FL CH 7767) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2013-06-12 |