| NPI | 1013950765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000815) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00345) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-05-16 |