| 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 |