| NPI | 1881259570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12813) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: FL 12813) |
| 111NR0400X Chiropractor Rehabilitation (Licence: FL 12813) | |
| 111NX0100X Chiropractor Occupational Health (Licence: FL 12813) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |