| NPI | 1730329483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011830-1) |
| 111N00000X Chiropractor (Licence: VT 006.0066728) | |
| 111N00000X Chiropractor (Licence: MA 3402) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2016-07-29 |