| NPI | 1780615450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 13771261-1202) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2025-12-30 |