| NPI | 1528387545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3458) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00609) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2015-01-14 |