| NPI | 1730267170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0075459) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR006646) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2013-02-27 |