| NPI | 1114970860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4101) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-06-06 |