| NPI | 1710093737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: MA 866) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 866) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-04-09 |