| NPI | 1922111749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12775) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1112) |
| 111N00000X Chiropractor (Licence: ID CHIA-1670) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-04-22 |