| NPI | 1881977064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ME CR2312) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3352) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2018-07-23 |