| NPI | 1982060091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3623) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2031) |
| 111N00000X Chiropractor (Licence: NY 012786) | |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2019-08-22 |