| NPI | 1164449625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2915) |
| 111N00000X Chiropractor (Licence: NY X010778-1) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-05-18 |