| NPI | 1467691725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 1219) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006-0001213) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2025-01-23 |