| NPI | 1881355204 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3779) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3535) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-04-22 |