| NPI | 1225102577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11014) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 11014) |
| 111NX0800X Chiropractor Orthopedic (Licence: CO 5792) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-08-25 |