| NPI | 1790974749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CH652) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MA CH652) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2018-03-17 |