| NPI | 1437154986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001090) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VT 1090) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2011-12-20 |