| NPI | 1952470353 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: OH 867) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: VT 824) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-09 |