| NPI | 1760635064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 006.0134120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011714) |
| 111N00000X Chiropractor (Licence: NC 3968) | |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2018-09-25 |