| NPI | 1548668304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH Dc-04649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR2256) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2018-01-02 |