| NPI | 1982865747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556699) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 111N00000X Chiropractor (Licence: NY 011636) | |
| 111N00000X Chiropractor (Licence: NC 3917) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2013-06-19 |