| NPI | 1184762221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA BE905) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-05-04 |