| NPI | 1386744837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 1840) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00491) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2010-06-09 |