| NPI | 1205130051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11619) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP2928) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2016-02-04 |