| NPI | 1720173891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104002042) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH5818) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-03-21 |