| NPI | 1609991819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3780) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1092) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-04-25 |