| NPI | 1003219825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11072) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5880) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |