| NPI | 1023109204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR584) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ME CRA1195) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-04-18 |