| NPI | 1073713988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR549) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC003198R) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |