| NPI | 1568641652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR858) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: ME R034894) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2010-09-09 |