| NPI | 1972142099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3740) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0001005) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2021-08-09 |