| NPI | 1467532036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1144) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 625-0201) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |