| NPI | 1225213259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL Ch9504) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: FL Ch9504) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2020-07-01 |