| NPI | 1821145921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VT 0060001149) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0001149) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2023-04-21 |