| NPI | 1265581664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NH 144-1154-0584A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 144-1154-0584A) |
| 111NR0400X (Licence: NH 144-1154-0584A) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NH 144-1154-0584A) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-12-29 |