| NPI | 1306316237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12606) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-013-137) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2024-04-16 |