| NPI | 1154621092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 875) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2011-07-11 |