| NPI | 1275970691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12593) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 956) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2018-10-05 |