| NPI | 1255431755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1311) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2460) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2015-11-30 |