| NPI | 1316040777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1055) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 761) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2022-08-18 |