| NPI | 1922469733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12370) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME CR2277) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2018-01-31 |