| NPI | 1033375639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32078) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008390) |
| 111N00000X Chiropractor (Licence: FL 10157) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2011-09-19 |