| NPI | 1780731851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1626) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MA 1626) |
| 111NX0800X Chiropractor, Orthopedic (Licence: MA 1626) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-12-15 |