| NPI | 1083808596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6780) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 0006780) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2023-03-10 |