| NPI | 1700883832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 279-0297) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2176) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2007-07-08 |