| NPI | 1063455731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR580) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 38007840) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-12-08 |