| NPI | 1821025438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1740) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3775) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-03-17 |