| NPI | 1720091994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NH 128-0655-0184A) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CT 565) |
| 111NX0800X Chiropractor, Orthopedic (Licence: MA 896288) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |