| NPI | 1063840585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2691) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12752) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2022-06-03 |