| NPI | 1194706549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2083) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI dcp00605) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2014-12-18 |