| NPI | 1255637666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: MA 3478) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY X012124-1) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2022-09-15 |