| NPI | 1083480990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2966) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: ME CR2966) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-01 |