| NPI | 1992737803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 15986) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001974) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-09-18 |