| NPI | 1861467524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 02980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104000343) |
| 111N00000X Chiropractor (Licence: VT 0060000625) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |