| NPI | 1760783930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10682) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05364) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2014-04-02 |