| NPI | 1720384159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: VT 006.0091379) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY x012130) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2022-11-10 |