| NPI | 1003902412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 04701520380a) |
| 111N00000X Chiropractor (Licence: FL 3426) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |