| NPI | 1932398336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 13059) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4886) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2024-03-13 |