| NPI | 1730373804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0134161) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4206) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2025-02-20 |