| NPI | 1174600050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001184) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 60001148) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-10-19 |