| NPI | 1689624298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00440) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004370) |
| 111N00000X Chiropractor (Licence: MA 1046) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-07-30 |