| NPI | 1487666426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CHI718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 718) |
| 111N00000X Chiropractor (Licence: NH 270-0687B) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2025-08-04 |