| NPI | 1124192398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2643) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI dcp00479) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2019-08-14 |