| NPI | 1831427624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4048) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9830) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2016-01-11 |