| NPI | 1437452851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0079419) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007379) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2011-07-19 |