| NPI | 1861759730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3850) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10623) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2016-12-20 |