| NPI | 1720153067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2566) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI 475) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2016-06-23 |