| NPI | 1548348568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 074-0491) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1796) |
| 111N00000X Chiropractor (Licence: NY X006324-1) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |