| NPI | 1801863808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 2280686A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA CH1100) |
| 111N00000X Chiropractor (Licence: ME CR696) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |