| NPI | 1063540383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 632-0401) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2584) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2016-10-17 |