| NPI | 1639682495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5386-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12345) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2018-11-13 |