| NPI | 1538685797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2085) |
| Enumeration Date | 2017-08-19 |
| Last Update Date | 2024-04-11 |