| NPI | 1023016813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6447) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006294) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2023-09-27 |