| NPI | 1083129225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI 00668) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2092) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2022-10-05 |