| NPI | 1235155920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00530) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2339) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-05-11 |