| NPI | 1356776827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 083179) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10985) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2017-09-05 |