| NPI | 1447317367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA MA1061) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: MA 1610) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2021-03-05 |