| NPI | 1568484889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 5835) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-01-25 |