| NPI | 1053808345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 1064) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR2495) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2021-12-23 |