| NPI | 1043801210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00684) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3717) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2025-01-10 |