| NPI | 1609861889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 451) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME 482) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2010-06-30 |