| NPI | 1033285259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1960) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001876) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-04-20 |