| NPI | 1962418152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch10085) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002280A) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2012-06-21 |