| NPI | 1366542532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2084) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06446) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-02-22 |