| NPI | 1780915405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1990) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70011814) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2014-06-17 |