| NPI | 1417414715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 1037) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0134125) |
| 111N00000X Chiropractor (Licence: MA 3637) | |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2025-01-26 |