| NPI | 1417990896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR593) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 708) |
| 111N00000X Chiropractor (Licence: CT 000389) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |