| NPI | 1578601027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00550) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010858) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2008-01-10 |