| NPI | 1659479509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2921) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 747-0905) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-02-21 |