| NPI | 1093830069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 633) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 14006) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2014-08-28 |