| NPI | 1417138553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 887) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2109) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2012-01-26 |