| NPI | 1861752941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12353) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012195) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2020-07-28 |