| NPI | 1760480131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CHI2218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL9751) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2025-10-02 |