| NPI | 1932216140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3430) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY x010471) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2015-02-04 |