| NPI | 1083716336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1716) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR879) |
| 111N00000X Chiropractor (Licence: NH 096-0492A) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2011-06-14 |