| NPI | 1750420097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 0060000863) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00200700) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |