| NPI | 1174921464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 11362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012539) |
| 111N00000X Chiropractor (Licence: DE F1-0000912) | |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2015-11-10 |