| NPI | 1003886433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5636) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7244) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-09 |