| NPI | 1295270049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12051) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3087) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2019-04-19 |