| NPI | 1750427787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2221) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 008644) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2016-02-03 |