| NPI | 1043366347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3594) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IN 08001237) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2021-05-25 |