| NPI | 1750343992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0064013) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: VT 06.0064013) |
| 111NN1001X Chiropractor Nutrition (Licence: VT 06.0064013) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2012-07-13 |