| NPI | 1720421894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: MA 2858) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: RI DCP00392) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2013-04-09 |