| NPI | 1154331197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR1900) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-08-06 |