| NPI | 1467797662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 11289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA dc010674) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2022-07-21 |