| NPI | 1174618029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 0060001103) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010508) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-09-18 |