| NPI | 1518068170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 062-0491-A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1633) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-05-26 |