| NPI | 1508011610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 000454) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9824) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2018-07-19 |