| NPI | 1275884819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 946) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3382) |
| Enumeration Date | 2012-09-23 |
| Last Update Date | 2015-07-28 |