| NPI | 1568642932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009819) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2008-03-12 |