| NPI | 1215513924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3750) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 002121) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-11-04 |