| NPI | 1689096596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3511) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012463-1) |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2021-12-01 |