| NPI | 1407128895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001906) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME 2389) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2019-09-04 |