| NPI | 1487780433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL APRN11005504) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: FL CH9098) |
| 111N00000X Chiropractor (Licence: FL CH9098) | |
| 208D00000X General Practice (Licence: FL CH9098) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-09-18 |