| NPI | 1881873362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3233) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001731) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2012-02-27 |