| NPI | 1912931841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP 00521) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-07-10 |