| NPI | 1003828377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI 301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 905) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-12-06 |