| NPI | 1164513503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 265-0687B) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MA 1238) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-01-10 |