| NPI | 1588047880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1822) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11380) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2015-07-04 |