| NPI | 1255360855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: FL 5711) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH5911) |
| 111N00000X Chiropractor (Licence: CT 000681) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: CT 000681) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-11-01 |