| NPI | 1194151779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10994) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5830) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2014-01-31 |