| NPI | 1366796351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13295) |
| Additional Taxonomies | 111NR0400X (Licence: UT 8381395-1202) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2021-12-22 |