| NPI | 1265431365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 692) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X003141) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-07-08 |