| NPI | 1003000415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10056) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3177) |
| 111N00000X Chiropractor (Licence: GA CHIR008295) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2017-02-08 |