| NPI | 1811089576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: MA 1524) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: MO 2006022689) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-07-09 |