| NPI | 1316357775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11196) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1742) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2021-02-17 |