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 |