| NPI | 1114924917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA MA 1138) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ NJ38MC000606000) |
| 111N00000X Chiropractor (Licence: CT CT000635) | |
| 111N00000X Chiropractor (Licence: NY X011065-1) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |