| NPI | 1326280348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00578) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2023-04-24 |