| NPI | 1639824030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3774) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00696) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-04-18 |