| NPI | 1639181621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: FL CH 10315) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: FL cfc 9) |
| 111N00000X Chiropractor (Licence: NC 3343) | |
| 111N00000X Chiropractor (Licence: IL 038.011037) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-09-21 |