| NPI | 1801908314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2075) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0083881) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-07-06 |