| NPI | 1093044000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2012015609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR1922) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2021-03-16 |