| NPI | 1467419887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006-0001141) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X08954) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2017-08-17 |