| NPI | 1679296818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3810) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: MA 3810) |
| 111NS0005X Chiropractor Sports Physician (Licence: MA 3810) | |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-22 |