| NPI | 1679374961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CHI5196) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 37239) |
| Enumeration Date | 2025-03-21 |
| Last Update Date | 2025-12-23 |