| NPI | 1013221217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH-10714) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556778) |
| 111N00000X Chiropractor (Licence: NC 4097) | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2014-09-28 |