| NPI | 1821507138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2351) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ME CRA2501) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2019-03-04 |