| NPI | 1407890890 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040-0003483) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-03-21 |