| NPI | 1457694531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3416) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012339) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2015-02-22 |