| NPI | 1881999324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 868-0510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3277) |
| 111N00000X Chiropractor (Licence: ME CR2016) | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2014-05-09 |