| NPI | 1801128004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3311) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 5241564651) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2011-11-02 |