| NPI | 1053881300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4639) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12384) |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2021-05-19 |