| NPI | 1053373514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CHI1232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1232) |
| 111N00000X Chiropractor (Licence: NH 278-687A) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2024-10-28 |