| NPI | 1003952573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9576) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008143) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR008143) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-01-26 |