| NPI | 1285855833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1258) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MA 1258) |
| 111NR0200X Chiropractor, Radiology (Licence: MA 1258) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |