| NPI | 1205818184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25872) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2025-12-17 |