| NPI | 1205998002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor Radiology (Licence: ME CR1234) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR1234) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2025-09-11 |