| NPI | 1003024886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001056) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 383) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |