| NPI | 1962640573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556696) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: VA 0104556696) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2010-11-12 |