| NPI | 1134206808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3226) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001688) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-05-06 |