| NPI | 1942237904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556607) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00438) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2024-05-30 |