| NPI | 1992443535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: RI DCP00730) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 1124) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2025-06-18 |