| NPI | 1295196764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: VT 006.0134187) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012816) |
| 111NN0400X Chiropractor, Neurology (Licence: NY 012816) | |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2024-04-29 |