| NPI | 1760668511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2258) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29759) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2011-12-13 |