| NPI | 1013936632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1458) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A5419) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-11-05 |