| NPI | 1043515810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10172) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2011-11-01 |