| NPI | 1265437040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3146) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 242) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2017-10-12 |