| NPI | 1043629074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch12432) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5969) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2019-07-25 |