| NPI | 1770781072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9409) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4318-12) |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2018-06-27 |