| NPI | 1124162367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: VT 006-0000870) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: VT 006-0000870) |
| 111NN1001X Chiropractor, Nutrition (Licence: VT 006-0000870) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2015-08-14 |