| NPI | 1184673691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1124) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 5610599) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-04-01 |