| NPI | 1033207048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3050) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00539) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2010-04-23 |