| NPI | 1568545580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor Independent Medical Examiner (Licence: RI DCP00545) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00545) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-05-23 |