| NPI | 1750360376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1096) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MA 1096) |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MA 1096) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2012-12-12 |