| NPI | 1538890769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0134191) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3786) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2023-11-28 |