| NPI | 1720149230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00574) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3104) |
| 111N00000X Chiropractor (Licence: CA DC30042) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2008-10-14 |