| NPI | 1750652053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03768) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10473) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2017-02-01 |