| NPI | 1477095461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL Ch12044) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60702159) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2019-04-14 |