| NPI | 1497734586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 596-0400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2606) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2008-01-02 |