| NPI | 1366955288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2546) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5551) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2018-11-08 |