| NPI | 1366262743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00711) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA CHI3652) |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2025-08-28 |