| NPI | 1306253216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3465) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MA 3465) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2023-08-11 |