| NPI | 1790934537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR1906) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03563) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2016-11-16 |