| NPI | 1831469691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11874) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4242) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2016-07-29 |