| NPI | 1700133071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557000) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2019-07-31 |